Adult overweight and obesity is a life-threatening health concern worldwide. Bariatric surgery is a successful treatment for severely obese individuals however, there is a moderate risk for weight regain. This study evaluated perception of food, supportive resistance resources, and nutrition knowledge, which play important roles in successful weight loss post bariatric surgery. Participants completed a three-part questionnaire at three time intervals: prior to surgery, 2 months post-surgery, and 5 months post-surgery. Results show that bariatric patients’ eating behavior significantly changes post bariatric surgery, but a disordered perception of food remains. Bariatric surgery patients believe support from significant others and family are most important and physical activity will help prevent weight regain. Results indicate that bariatric patients’ nutrition knowledge decreases over time and additional nutrition education may be needed within the first-year post-surgery. More research should be conducted in the area of bariatric surgery and how to prevent weight regain.

A obesidade grau III ou também chamada obesidade mórbida é uma condição clínica freqüente e que vem apresentado crescimento progressivo, estando associada a elevadas taxas de morbi-mortalidade. Trata-se de uma doença de origem multifatorial, freqüentemente associada a comorbidezes, necessitando uma abordagem terapêutica que propicie redução de peso, melhora das doenças associadas e conseqüente melhora da qualidade de vida. O tratamento convencional deve ser sempre a primeira escolha, principalmente nos casos de inicio recente e sem antecedentes de tratamentos adequados prévios. A taxa de insucesso, contudo, é extremamente elevada, ocorrendo falha em mais de 90% dos casos. O tratamento cirúrgico atualmente é a alternativa com melhores resultados, porém com riscos de complicações a curto, médio e longo prazo, caso não seja realizado um rigoroso acompanhamento clinico, nutricional e psicológico em equipe multidisciplinar experiente. Esta revisão tem por objetivo discorrer sobre as morbidades associadas à obesidade grave, as opções de tratamento convencional e cirúrgico bem como riscos relacionados à persistência de um grande excesso de peso versus risco cirúrgico. / Morbid obesity is a frequent disease with a progressive increase in incidence and associated with high morbid and mortality rates. It is a multifactorial disease, and is usually associated with comorbidities. It is necessary specific treatment to reduce weight, to improve the comorbidities and obtain a better quality of life. The classic treatment, diet and exercise, should be the first choice, especially in cases of recent onset of severe obesity and poor quality previous treatments. Unfortunately, in more than 90% of the patients this kind of treatment will fail. Bariatric surgery is, nowadays, the best option of treatment, but has several risks of complications in the short, medium or long time followup, mostly in patients not followed by a specialized multidisciplinary team. This is a review about morbid obesity, comorbidities, options of treatment and the risks of stay severely obese versus surgical procedures.

A obesidade grau III ou também chamada obesidade mórbida é uma condição clínica freqüente e que vem apresentado crescimento progressivo, estando associada a elevadas taxas de morbi-mortalidade. Trata-se de uma doença de origem multifatorial, freqüentemente associada a comorbidezes, necessitando uma abordagem terapêutica que propicie redução de peso, melhora das doenças associadas e conseqüente melhora da qualidade de vida. O tratamento convencional deve ser sempre a primeira escolha, principalmente nos casos de inicio recente e sem antecedentes de tratamentos adequados prévios. A taxa de insucesso, contudo, é extremamente elevada, ocorrendo falha em mais de 90% dos casos. O tratamento cirúrgico atualmente é a alternativa com melhores resultados, porém com riscos de complicações a curto, médio e longo prazo, caso não seja realizado um rigoroso acompanhamento clinico, nutricional e psicológico em equipe multidisciplinar experiente. Esta revisão tem por objetivo discorrer sobre as morbidades associadas à obesidade grave, as opções de tratamento convencional e cirúrgico bem como riscos relacionados à persistência de um grande excesso de peso versus risco cirúrgico. / Morbid obesity is a frequent disease with a progressive increase in incidence and associated with high morbid and mortality rates. It is a multifactorial disease, and is usually associated with comorbidities. It is necessary specific treatment to reduce weight, to improve the comorbidities and obtain a better quality of life. The classic treatment, diet and exercise, should be the first choice, especially in cases of recent onset of severe obesity and poor quality previous treatments. Unfortunately, in more than 90% of the patients this kind of treatment will fail. Bariatric surgery is, nowadays, the best option of treatment, but has several risks of complications in the short, medium or long time followup, mostly in patients not followed by a specialized multidisciplinary team. This is a review about morbid obesity, comorbidities, options of treatment and the risks of stay severely obese versus surgical procedures.

A obesidade grau III ou também chamada obesidade mórbida é uma condição clínica freqüente e que vem apresentado crescimento progressivo, estando associada a elevadas taxas de morbi-mortalidade. Trata-se de uma doença de origem multifatorial, freqüentemente associada a comorbidezes, necessitando uma abordagem terapêutica que propicie redução de peso, melhora das doenças associadas e conseqüente melhora da qualidade de vida. O tratamento convencional deve ser sempre a primeira escolha, principalmente nos casos de inicio recente e sem antecedentes de tratamentos adequados prévios. A taxa de insucesso, contudo, é extremamente elevada, ocorrendo falha em mais de 90% dos casos. O tratamento cirúrgico atualmente é a alternativa com melhores resultados, porém com riscos de complicações a curto, médio e longo prazo, caso não seja realizado um rigoroso acompanhamento clinico, nutricional e psicológico em equipe multidisciplinar experiente. Esta revisão tem por objetivo discorrer sobre as morbidades associadas à obesidade grave, as opções de tratamento convencional e cirúrgico bem como riscos relacionados à persistência de um grande excesso de peso versus risco cirúrgico. / Morbid obesity is a frequent disease with a progressive increase in incidence and associated with high morbid and mortality rates. It is a multifactorial disease, and is usually associated with comorbidities. It is necessary specific treatment to reduce weight, to improve the comorbidities and obtain a better quality of life. The classic treatment, diet and exercise, should be the first choice, especially in cases of recent onset of severe obesity and poor quality previous treatments. Unfortunately, in more than 90% of the patients this kind of treatment will fail. Bariatric surgery is, nowadays, the best option of treatment, but has several risks of complications in the short, medium or long time followup, mostly in patients not followed by a specialized multidisciplinary team. This is a review about morbid obesity, comorbidities, options of treatment and the risks of stay severely obese versus surgical procedures.

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Bakgrund: Försämrade levnadsvanor i samhället har inneburit en ökning av fetma bland befolkningen. Sjuklig övervikt behandlas bland annat genom obesitaskirurgi. Syfte: Litteraturstudiens syfte var att belysa patienters upplevelse av hur livet påverkas efter genomgången obesitaskirurgi. Metod: En litteraturstudie genomfördes där nio kvalitativa studier granskades, analyserades och sammanställdes med hjälp utifrån en innehållsanalys. Resultat: I litteraturstudiens resultat presenteras att genomgången obesitaskirurgi innebar en omfattande kroppslig förändringsprocess för patienterna. Operationen medförde nya fysiska förutsättningar men även oväntade negativa effekter. Till följd av förändringen lärde sig patienterna att hantera viktminskningen och vidare beskrevs en återupptäckt av sig själv. Att vara en individ utanför normen innebar upplevelser av en förändrad stigmatisering och ett engagemang från omgivningen. Positiva och negativa upplevelser presenteras bland patienter av både manligt och kvinnligt kön. Konklusion: Litteraturstudiens resultat visade att genomgången obesitaskirurgi var en livsomvälvande upplevelse som innebar både fysiska och psykiska förändringar bland patienterna. / Background: Various elements in the society and bad habits have resulted in an increased number of people living with obesity. One method to treat obesity today is to undergo bariatric surgery. Aim: The aim of this literature study was to highlight patients’ experiences of life effects after bariatric surgery. Methods: A literature study was conducted and nine qualitative scientific articles were reviewed, analysed and compiled with a content analysis. Results: In the result of the literature study it was presented that bariatric surgery were an extensive process of bodily change. The operation induced new physical preconditions but also negative and unexpected side effects of the surgery. As a result of the process the patients had to handle the weight loss and further rediscover oneself. To be an individual outside the criterion meant an altered stigmatization and dedication of the surroundings. Positive and negative experiences were described among both male and female patients. Conclusion: To undergo bariatric surgery was a life changing experience, which involved both physical and psychological changes.

Introduction: Bariatric surgery (BS) is currently the most effective treatment for morbid obesity. However, many individuals fail to lose or maintain adequate weight loss. It is a challenge to understand why some individuals can make the required changes following BS and some cannot. Evidence suggests that emotional eating (EE) may be associated with poorer outcome. However, there is as yet no conclusive research or review of the research in this area. Method: A systematic review was conducted with the aim to examine how EE relates to BS outcome. This review was complimented by a qualitative research project examining the experiences of individuals following weight loss surgery, with a particular focus on what changes and emotional coping. Results: Systematic review results suggest that EE is associated to poorer weight loss following BS. Six superordinate themes emerged from the qualitative research project; Surgery Outcome, Changing Views of the Self, Coping with Emotions, Being Judged Negatively, Being Obese is a Barrier to Living and It’s a Different Addiction. Discussion The overall results suggest that EE is an ongoing issue following bariatric surgery. BS seems to initiate various changes in behaviour, and cognition, together with increased sense of control. However, such changes seem to be attributed to BS, which is suggestive of an underestimation of self efficacy. Perceptions of obesity being the result of an addiction and emphasis on the difficulties associated with losing weight further highlight the issue of reduced self efficacy. This study also highlights that for many, having surgery does not cure all difficulties associated with eating. There are possibly underlying difficulties associated with obesity, such as neurocircuitry pathways that increase desire for food, whilst reducing control and attachment difficulties that reduce emotion regulation capacity. However, much work is required to understand such explanations and develop appropriate psychological interventions. Conclusion: The overall results from this thesis provide support for the view that EE and associated emotion regulation difficulties are related to poorer BS outcome. What seems clear from this research is that, although BS provides many positive changes, the battle against obesity continues for most and services are currently limited in their resources to intervene.

The role of a psychologist within bariatric services is predominately focussed on the completion of preoperative psychological assessments (NICE, 2006; Ratcliffe et al, 2014). This role requires the psychologist to determine the suitability of the patient for surgery (Bauchowitz et al., 2005; Fabricatore et al., 2006; Sogg & Mori, 2004; UK Faculty of clinical health psychology; Psychologists in weight management network meeting, 2013), however no research to date has been able to reliably determine which variables could be associated with sub optimal weight loss (Sarwer, Wadden, & Fabricatore, 2005; Van Hout, Verschure, and van Heck, 2005; Wadden, Sarwer, Fabricatore, 2007). The first part of this study examines the empirical evidence for a range of variables considered by professionals to be clear contraindications to surgery. The variables were collated from surveys conducted in America (Bauchowitz et al., 2005; Fabricatore et al., 2006). Due to conflicting evidence and various problems with the studies it is difficult for a clinician to draw any firm conclusions from the review. Therefore, an ideographic approach is suggested, which leads onto the second part of the researcher dossier. The empirical chapter presents an interpretative phenomenological analysis (IPA) of interviews with 14 bariatric participants who were 12 months to three years post-operative to explore their experience of - 21 surgery. This time frame was chosen to capture the participants after the ‘honeymoon phase’ when the participants have hit their weight plateau (Yale & Weiler, 1991; Brolin, 1992). The themes from the study were ‘pre op’ ‘phases’ weight maintenance’ ‘impact of the operation’ and an overall psychological theme of ‘locus of control’. Support was a key area for the participants, they described the lack of support they felt from professionals and means of seeking support elsewhere. The themes also highlighted the psychological struggle the participants go through post operatively with eating, however, this is balanced with the positive changes in identity and their ability to engage with life, no longer impeded by their weight. Recommendations from the study suggest the importance of psychologists being available to bariatric patients, in accordance with NICE guidance, and that all bariatric patients start their journey to surgery in a level three service (which is a weight management service with consists of a multi-disciplinary team) before being referred to the tier four surgical team. Finally weight loss prior to surgery is recommended, with an alternative method of achieving this than that presented in the recent British Obesity and Metabolic Surgery Society (2014) publication.

Este estudo transversal teve como objetivo avaliar o Limiar de Dor a Pressão (LDP) e a capacidade mastigatória de pacientes obesos com indicação para cirurgia bariátrica. Foi composto por 90 pacientes, sendo 60 com perda de elementos dentários que indiquem reabilitação oral (grupo experimental-GE) e 30 totalmente dentados (grupo controle-GC). A coleta de dados foi realizada em dois períodos para o grupo experimental, antes e após a confecção da prótese segundo sua indicação. Já no grupo controle a coleta foi realizada em tempo único. A coleta compreendeu os teste de Limiar de dor a pressão (LDP), escala de análise visual (EAV) para sensação dolorosa, teste de fadiga muscular, capacidade e eficiência mastigatórias e análise da qualidade de vida por meio do Oral Health Impact Profile (OHIP-14). Após verificada a normalidade das variáveis, o teste t de Student foi utilizado para avaliar as diferenças entre os grupos de dentados e desdentados e para avaliação do inicial para o final do grupo experimental. Para avaliar as diferenças entre os períodos dos testes de fadiga mastigatória foi realizada ANOVA para medidas repetidas seguida pelo teste de Tukey. O LDP conservou-se com características de normalidade antes e após a instalação da prótese dentária, apesar da redução do limiar para alguns grupos musculares. Ao se comparar ao grupo controle não houve distinções, com exceção do músculo masseter (p=0,012). Apesar de não haver queixa de dor a EAV obteve uma redução estatística (p=0,000) após a instalação da prótese para o GE, se tornando ainda mais reduzida. O teste de fadiga mastigatória se apresentou similar entre os grupos, entretanto, o LDP e a EAV no decorrer do teste indicaram modificações entre os tempos, porém os aspectos de normalidade foram mantidos. A capacidade e eficiência mastigatória do GE evoluiu após o tratamento protético (p=0,000), embora o grupo controle (dentados) continuasse superior (p=0,000). A análise do OHIP, para ambos os grupos, demonstrou que a condição bucal desses pacientes não interfere em sua qualidade de vida. Concluiu-se que a análise do limiar de dor a pressão demonstrou que a condição dentária, presença ou ausência de dentes, em pacientes obesos mórbidos obteve níveis considerados normais para pacientes assintomáticos para dor orofacial. A capacidade e eficiência mastigatória apresentaram uma melhora significativa após a reabilitação oral, entretanto, não atingiram níveis semelhantes ao do grupo controle. Os pacientes obesos mórbidos indicados à cirurgia bariátrica devem ser submetidos ao tratamento odontológico, especialmente à reabilitação oral, antes e após a cirurgia, colaborando com a nova condição sistêmica do paciente. / This cross-sectional study aimed to evaluate the Pain Threshold Pressure (PTP) and masticatory capacity of obese patients referred for bariatric surgery. It was composed of 90 patients, 60 with tooth loss indicating oral rehabilitation (EG-experimental group) and 30 fully dentate (control group-CG. Data collection was conducted in two periods for the experimental group before and after the making of the prosthesis according to his statement. In the control group, the collection was performed in one time. The collection comprised the test pressure pain threshold (PTP), visual analysis scale (VAS) for pain sensation, muscle fatigue test, ability and masticatory efficiency and analysis of quality of life using the Oral Health Impact Profile (OHIP -14). After verified the normality of the variables, the Student\'s t test was used to assess differences between the groups of toothed and toothless and for evaluating the initial to the end of the experimental group. To evaluate the differences between the periods of masticatory fatigue testing was performed ANOVA for repeated measures followed by the Tukey test. The PTP kept up with normal characteristics before and after installation of dental prosthesis, despite the lowering of the threshold for some muscle groups. Comparied to the control group there were no distinctions, except the masseter (p = 0.012). Although there was no complaint of pain VAS scores a statistical reduction (p = 0.000) after installation of the prosthesis for GE, becoming even smaller. The masticatory fatigue test appeared similar between groups, however, the PTP and the VAS during the test indicated changes between times, but aspects of normality were kept. The ability and masticatory efficiency of GE evolved after prosthetic treatment (p = 0.000), although the control group (toothed) remained higher (p = 0.000). The analysis of OHIP, for both groups, showed that oral condition of these patients does not interfere with their quality of life. It was concluded that the analysis of the pressure pain threshold showed that the dental status, presence or absence of teeth, in morbidly obese patients achieved normal levels for asymptomatic patients for orofacial pain. The ability and masticatory efficiency showed a significant improvement after oral rehabilitation, however, did not reach levels similar to the control group. The morbidly obese patients referred for bariatric surgery should undergo dental treatment, especially oral rehabilitation before and after surgery, collaborating with the new systemic condition of the patient.

Este estudo transversal teve como objetivo avaliar o Limiar de Dor a Pressão (LDP) e a capacidade mastigatória de pacientes obesos com indicação para cirurgia bariátrica. Foi composto por 90 pacientes, sendo 60 com perda de elementos dentários que indiquem reabilitação oral (grupo experimental-GE) e 30 totalmente dentados (grupo controle-GC). A coleta de dados foi realizada em dois períodos para o grupo experimental, antes e após a confecção da prótese segundo sua indicação. Já no grupo controle a coleta foi realizada em tempo único. A coleta compreendeu os teste de Limiar de dor a pressão (LDP), escala de análise visual (EAV) para sensação dolorosa, teste de fadiga muscular, capacidade e eficiência mastigatórias e análise da qualidade de vida por meio do Oral Health Impact Profile (OHIP-14). Após verificada a normalidade das variáveis, o teste t de Student foi utilizado para avaliar as diferenças entre os grupos de dentados e desdentados e para avaliação do inicial para o final do grupo experimental. Para avaliar as diferenças entre os períodos dos testes de fadiga mastigatória foi realizada ANOVA para medidas repetidas seguida pelo teste de Tukey. O LDP conservou-se com características de normalidade antes e após a instalação da prótese dentária, apesar da redução do limiar para alguns grupos musculares. Ao se comparar ao grupo controle não houve distinções, com exceção do músculo masseter (p=0,012). Apesar de não haver queixa de dor a EAV obteve uma redução estatística (p=0,000) após a instalação da prótese para o GE, se tornando ainda mais reduzida. O teste de fadiga mastigatória se apresentou similar entre os grupos, entretanto, o LDP e a EAV no decorrer do teste indicaram modificações entre os tempos, porém os aspectos de normalidade foram mantidos. A capacidade e eficiência mastigatória do GE evoluiu após o tratamento protético (p=0,000), embora o grupo controle (dentados) continuasse superior (p=0,000). A análise do OHIP, para ambos os grupos, demonstrou que a condição bucal desses pacientes não interfere em sua qualidade de vida. Concluiu-se que a análise do limiar de dor a pressão demonstrou que a condição dentária, presença ou ausência de dentes, em pacientes obesos mórbidos obteve níveis considerados normais para pacientes assintomáticos para dor orofacial. A capacidade e eficiência mastigatória apresentaram uma melhora significativa após a reabilitação oral, entretanto, não atingiram níveis semelhantes ao do grupo controle. Os pacientes obesos mórbidos indicados à cirurgia bariátrica devem ser submetidos ao tratamento odontológico, especialmente à reabilitação oral, antes e após a cirurgia, colaborando com a nova condição sistêmica do paciente. / This cross-sectional study aimed to evaluate the Pain Threshold Pressure (PTP) and masticatory capacity of obese patients referred for bariatric surgery. It was composed of 90 patients, 60 with tooth loss indicating oral rehabilitation (EG-experimental group) and 30 fully dentate (control group-CG. Data collection was conducted in two periods for the experimental group before and after the making of the prosthesis according to his statement. In the control group, the collection was performed in one time. The collection comprised the test pressure pain threshold (PTP), visual analysis scale (VAS) for pain sensation, muscle fatigue test, ability and masticatory efficiency and analysis of quality of life using the Oral Health Impact Profile (OHIP -14). After verified the normality of the variables, the Student\'s t test was used to assess differences between the groups of toothed and toothless and for evaluating the initial to the end of the experimental group. To evaluate the differences between the periods of masticatory fatigue testing was performed ANOVA for repeated measures followed by the Tukey test. The PTP kept up with normal characteristics before and after installation of dental prosthesis, despite the lowering of the threshold for some muscle groups. Comparied to the control group there were no distinctions, except the masseter (p = 0.012). Although there was no complaint of pain VAS scores a statistical reduction (p = 0.000) after installation of the prosthesis for GE, becoming even smaller. The masticatory fatigue test appeared similar between groups, however, the PTP and the VAS during the test indicated changes between times, but aspects of normality were kept. The ability and masticatory efficiency of GE evolved after prosthetic treatment (p = 0.000), although the control group (toothed) remained higher (p = 0.000). The analysis of OHIP, for both groups, showed that oral condition of these patients does not interfere with their quality of life. It was concluded that the analysis of the pressure pain threshold showed that the dental status, presence or absence of teeth, in morbidly obese patients achieved normal levels for asymptomatic patients for orofacial pain. The ability and masticatory efficiency showed a significant improvement after oral rehabilitation, however, did not reach levels similar to the control group. The morbidly obese patients referred for bariatric surgery should undergo dental treatment, especially oral rehabilitation before and after surgery, collaborating with the new systemic condition of the patient.